Associations of adolescent menstrual symptoms with school absences and educational attainment: analysis of a prospective cohort study

Abstract

Menstrual symptoms may negatively impact academic achievement, but rigorous population-based studies are lacking. 2,698 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) self-reported heavy or prolonged bleeding and menstrual pain during adolescence and multivariable regression were used to estimate associations with linked data on absences and attainment at age 15/16, adjusting for confounders. Heavy or prolonged bleeding and pain were associated with missing 1.7 (16.58% increase) and 1.2 (12.83% increase) additional days of school per year, respectively, and 48% and 42% higher odds of persistent (≥10%) absence. Heavy or prolonged bleeding was associated with lower examination scores (-5.7 points) and 27% lower odds of achieving five standard passes. The association between pain and attainment was weaker but still present (-3.14 points; 95% CI: -7.46, 1.17; 16% lower odds of five standard passes). Greater research and support are needed to prevent adolescents' menstrual symptoms impacting their academic achievement.

Fig. 1

Linear regression analysis of the association between menstrual symptoms and GCSE score and school absences and logistic regression analysis of the association between menstrual symptoms and achieving five A*-C GCSEs including Maths and English and persistent absence (10% or more) (N = 2698). GCSE general certificate of secondary education, CI confidence interval. Adjusted for ethnicity; maternal education, parental social class, financial difficulties, and home ownership during pregnancy; maternal smoking pre-pregnancy; parental separation, physical abuse, and sexual abuse before 11; maternal depression at 12.1; age at menarche; body mass index at 12.8; internalising and externalising problems at 9.6; and intelligence quotient at 8.

Fig. 2. Flow diagram of the Avon longitudinal study of parents and children participants into the current study sample.

Black boxes represent the sample included in the main analysis and grey boxes show the additional exclusions to establish the sample used in the additional analysis regarding oral contraceptive use.